Therapy to eliminate sexual feelings
Submitted by Mark on February 10 2002 22:43:31
|
I found an interesting 1972 article from the Gay News about aversion therapy: AVERSION THERAPY IS "LIKE A VISIT TO THE DENTIST" Here's a summary: "Aversion therapy" was used until the 1970s in attempts to change or eliminate homosexual feelings. Its goal was to change the patient’s "sexual arousal pattern" by associating pain or discomfort with his usual sexual fantasies or feelings. This was done by presenting the patient with nude or pornographic pictures or films known to arouse him while applying an unpleasant "aversive stimulus" such as drug-induced nausea, noxious odors, and electric shock. A penile plethysmograph, an electronic device connected to the man's penis, was typically used during the sessions to measure sexual arousal. According to the article, a leading proponent of aversion therapy was well-known British psychologist Hans Eysenck, who explained that it was based on Pavlov’s experiments on conditioned reflexes. According to Eysenck, it was "used to change the emotions, where the person cannot change them of his own free will.... By associating emotion with pain or fear, the emotional response can be re-conditioned." Thus the patients learned to associate their sexual feelings with pain and fear. The author of the article compared Eysenck with Nazi leader Heinrich Himmler for his views on homosexuality and advocacy of this approach. He confronted Eysenck at a conference and claimed that the therapy was unethical and caused patients to became asexual and to suffer from chronic depression. Eysenck responded by saying there was "no relationship between aversion therapy and punishment....it does not involve sadistic motivations....The fact is that aversion therapy is used for the patients’ own good." Technically, aversion therapy was only to be used with the consent of the patient; however, gay activists said they were virtually forced to undergo it in order to avoid prison. In addition, the article claims that the pain and discomfort of the therapy were minimized by those who administered it. Eysenck maintained that it was "just like a visit to the dentist....It is no different from any other form of therapy...there is no ethical principle involved in aversion therapy that is not involved in any psychological treatment." Another proponent, Isaac Marks, said aversion therapy should be used when the "patient asks for help" or when it was "in society’s interest....to be relieved of the burden of an individual." This second criteria was particularly troubling to the author who questioned this "ends justify the means" mentality. He feared it could be used against any minority incurring social disapproval. The mental health community eventually concurred; by the mid 1970s aversion therapy for eliminating homosexuality was abandoned as a failure and as ethically objectionable. More recently, conservative Christian groups have advocated the use of much more humane "reparative" therapy to change or eliminate homosexual behavior or patterns of arousal. According to most major health and mental health organizations, the effectiveness of reparative therapies has not been determined. There is anecdotal evidence both supporting and refuting their effectiveness; some clinicians claim some patients have been able to change their sexual feelings and/or behavior, and feel more at peace after this change. Others claim that some patients emerge from reparative therapy suffering from self-hate, depression, anxiety, distrust of mental health professionals, and sometimes even suicidal thoughts. Few studies on this question have been published in peer-reviewed journals, and few longitudinal surveys have been conducted to track the long-term outcome of clients who have completed these therapies. The studies that have been published have serious deficiencies. Thus, professional organizations have recently taken the same position on these therapies that they took on the therapies that ended in the 1970s. They say that the potential benefits and dangers of reparative therapies are not clearly known. Some also question whether therapists who use them inform their patients completely of their lack of scientific validity and their possible risks. The situation has been compared to that of other recent, experimental forms of therapy such as recovered memory therapy and multiple personality disorder therapy, which were eventually found to cause psychological damage, sometimes quite severe. Now consider these two recent articles: "Practice Parameters for the Assessment and Treatment of Children and Adolescents Who Are Sexually Abusive of Others," Journal of the American Academy of Child and Adolescent Psychiatry, December, 1999 "Understanding Juvenile Sexual Offending Behavior: Emerging Research, Treatment Approaches and Management Practices", December, 1999, Center for Sex Offender Management. They describe the following therapies, especially for use on teenaged boys who are attracted to younger children or adolescents and therefore classified as "deviant". It should be noted that sometimes these boys are considered "sex offenders" for consensual activity with younger boys, or are in this therapy not because they have committed a crime, but because they are known to have "deviant" feelings. (I know one such situation personally; at age 16 he was required to undergo "therapy" with the plethysmograph and lie detector.) Behavior Re-conditioning The goal of this approach is to change patterns of sexual arousal by helping the patient associate his preferred pattern with an unpleasant stimulus. There are several variations. Covert Sensitization. Scenes are constructed for each patient according to his or her preferred sexual-erotic fantasies. He is told to eliminate pleasurable responses to this sexually stimulating imagery through the imagining of some negative reaction or aversive stimulus. Assisted Covert Sensitization. This involves the same procedure as above, with aversive stimuli such as noxious odors used to facilitate an aversive reaction. Imaginal Desensitization. The patient is told to use relaxation techniques to interrupt the sexually stimulating imagery and to inhibit the sexual arousal cycle. Olfactory Conditioning. Sexually stimulating imagery is presented which is followed by the presentation of a noxious odor. Satiation Techniques. The patient is first encouraged to masturbate to ejaculation in response to socially appropriate sexual fantasies with the concomitant feelings of affection and tenderness. After this experience the offender is required to masturbate to his preferred sexual fantasies. If the offender becomes aroused, he or she is told to switch to an appropriate fantasy or in some instances exposed to an aversive stimulus such as ammonia. Verbal satiation requires the dictation on an audiotape of imagery that is the most stimulating for the patient for at least 30 minutes after masturbation 3 times a week. It is assumed that the fantasy becomes boring and subsequently eliminated. Sexual Arousal Reconditioning. This involves the pairing of sexual arousal with appropriate sexual stimulation or sexual fantasies. Sex-drive reducing drugs Studies on the effectiveness of drug therapy have had inconsistent results. Little information exists about their safety and effectiveness when used on juveniles. However, that has not ruled out their use. There are two basic kinds: selective Serotonin Reuptake Inhibitors (SSRIs) and antiandrogens. SSRIs diminish sexual drive, sexual arousal, and sexual preoccupations. The SSRIs are effective in the treatment of obsessive-compulsive behaviors, and their use has been recommended for individuals with "deviant" or compulsive but non-deviant sexual preoccupations; i.e., "sexual addiction." They are most effective on those with sexual obsessions, but also markedly reduce all sexual fantasies and behavior regardless of sexuality, including those that are "deviant." Antiandrogens reduce testosterone levels which may contribute to sexually aggressive behavior, but evidence for this connection is conflicting. Some studies show no difference in testosterone levels between adolescent sex offenders and non-violent offenders, but higher levels in violent offenders. Decreased testosterone has been shown to reduce sexual drive, fantasies, and behaviors for people in general. Antiandrogen drugs are not approved by the Food and Drug Administration, may delay the onset of puberty, and may cause gynecomastia, hypersomnia, fatigue, depression, alterations in adrenal functioning, increased weight gain, gastrointestinal upset, headaches, sleep disturbances, malaise, and hyperglycemia. Thus these agents are reserved for the most severe sexual abusers and are generally discouraged for use in adolescents younger than 17 years of age. They should never be used as an exclusive approach. Plethysmograph This is an instrument that is attached to the juvenile's penis to assess sexual arousal by measuring blood flow to the penis during the presentation of potentially erotic stimuli. There is little research on its effectiveness with juveniles, and the research that exists suggests that age and tendency to deny compromise the validity of its readings. Most practitioners agree that this method should not be used on youth under the age of 14. It is most appropriate for older adolescent males who report "deviant" sexual interest, and/or those with more extensive histories of sexual offending. Under these circumstances, such assessments may be useful for identifying youths with emergent paraphilic (sexual deviation) disorders as well as helping juveniles to become more aware of patterns and strengthen non-problematic interests. Polygraph ("Lie detector") The purpose of a polygraph examination is to verify a perpetrator’s completeness regarding offense history and compliance with therapeutic directives and terms of supervision. The polygraph is used more often with adult offenders than with juveniles. To date, there is little research on the polygraph’s reliability and validity in the evaluation of juveniles. Research suggests that results can be affected by the client’s physical and emotional status, the client’s age and intelligence, and the examiner’s level of training and competency. Most practitioners using the polygraph indicate that the age threshold for use is approximately 14 years old. Issues of Consent Experts recommend that clinicians consider developing additional consent forms to cover the use of more controversial assessment or treatment procedures such as aversion therapy, the use of medications that are not accepted as standard of practice, and the use of the plethysmograph. These consent forms should be specific to the procedure and clearly identify any potential risks and benefits associated with it. Clients should understand that these procedures are voluntary and that they are free to decline them. (Of course it is "voluntary" in the same way that it was for gay men a few decades ago.) |
Follow ups: